Sah Birendra Kumar, Gang Zhu Zheng, Min Yan
Department of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University, School of Medicine Shanghai Institute of Digestive Surgery, Shanghai, China.
Hepatogastroenterology. 2008 Mar-Apr;55(82-83):738-43.
BACKGROUND/AIMS: Comparative surgical audit is a very important issue in surgical practice. The POSSUM (Physiological and Operative Severity Score for the enumeration of Morbidity and mortality) system has been proposed as the most efficient risk adjusting tool which can be used to compare surgical outcome among different units. POSSUM was applied for risk-adjusted auditing of different units in a single hospital.
In total, 357 gastric cancer patients who underwent radical resection or palliative procedures were analyzed retrospectively to evaluate predictive value of POSSUM scoring system and postop morbidity was compared among 5 different units in a single hospital.
POSSUM predicted well by correct analysis; the observed to expected morbidity ratio (O:E ratio) was 1.01 for patients overall. But there were significant differences in complication rates among different units, the O: E ratio ranging from 0.7-1.63.
POSSUM is a credible tool for predicting postop morbidity in gastric surgery. It provides risk-adjusted morbidity which can be compared directly. There was surprising difference in surgical outcome among different units of a single hospital, this demands more prospective researches to evaluate surgical outcome of different units. We conclude gastric cancer surgery should be performed in specialized centers.
背景/目的：比较性外科审计是外科实践中的一个非常重要的问题。POSSUM（用于计算发病率和死亡率的生理和手术严重程度评分）系统已被提议作为最有效的风险调整工具，可用于比较不同单位的手术结果。POSSUM被应用于一家单一医院不同单位的风险调整审计。
总共对357例行根治性切除或姑息性手术的胃癌患者进行回顾性分析，以评估POSSUM评分系统的预测价值，并比较一家单一医院5个不同单位的术后发病率。
POSSUM通过正确分析预测良好；总体患者的观察到预期发病率比（O:E比）为1.01。但不同单位之间的并发症发生率存在显著差异，O:E比在0.7至1.63之间。
POSSUM是预测胃癌手术后发病率的可靠工具。它提供了可直接比较的风险调整发病率。一家单一医院不同单位之间的手术结果存在惊人差异，这需要更多前瞻性研究来评估不同单位的手术结果。我们得出结论，胃癌手术应在专科中心进行。
